Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 2601 N Main St, Rockford, Illinois |
Authorized Official Name and Position | Don Daniels (VP) |
Authorized Official Contact | 8159662084 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 78866 Milwaukee WI 53278-8866 Ph: () - | 2601 N Main St Rockford IL 61103 Ph: (815) 987-1802 |
NPI Number | 1962854083 |
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Provider Enumeration Date | 07/13/2016 |
Last Update Date | 07/12/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962854083 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Gautam Gupta Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6090 Strathmoor Dr, Suite #4, Rockford, IL 61107 Phone: 815-229-1899 Fax: 815-231-1218 | |
Rockford School District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 N Gardiner Ave, Rockford, IL 61107 Phone: 815-398-3976 | |
Rockford Adult Medicine Associates S C Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 534 Roxbury Rd, Rockford, IL 61107 Phone: 815-381-7005 | |